BJU international
-
Multicenter Study
International validation of the prognostic value of subclassification for AJCC stage pT3 upper tract urothelial carcinoma of the renal pelvis.
What's known on the subject? and What does the study add? Tumour stage is a powerful predictor of clinical outcomes and the most important factor driving clinical decision-making after radical nephroureterectomy (RNU) in upper tract urothelial carcinoma (UTUC). It has been suggested that renal pelvic pT3 subclassification into microscopic infiltration of the renal parenchyma (pT3a) versus macroscopic infiltration or invasion of peripelvic adipose tissue (pT3b) has strong prognostic value. This is an external validation study of the prognostic value of pT3 subclassification of renal pelvic UTUC in a large international cohort of patients treated with RNU. pT3b UTUC is associated with features of aggressive tumour biology, disease recurrence and cancer-specific mortality. However, pT3 subclassification is not an independent predictor of clinical outcomes. ⋯ Patients with pT3b UTUC were more likely to have tumours with aggressive pathological features and were at higher risk of disease recurrence and CSM after RNU compared with patients with pT3a disease. However, the pT3 subclassification did not remain an independent predictor of disease recurrence or CSM after controlling for tumour grade, lymph node status, tumour architecture and lymphovascular invasion.
-
What's known on the subject? and What does the study add? Patients with renal failure more frequently harbour RCC due to predisposing factors such as cystic disease of the kidney. The benefit of nephrectomy might be outweighed by adverse perioperative events, however, which may be more prevalent in patients with end-stage renal disease (ESRD). In a population-based study focusing on patients after non-elective colorectal surgery, patients with ESRD had an increased risk of mortality and complications. To date, small-scale studies have reported complication rates in patients with ESRD after nephrectomy for RCC with conflicting results. However, no formal contemporary analysis has been compiled within a nephrectomy cohort of adequate size. The present population-based case-control study showed that patients with ESRD are at substantially higher risk of in-hospital mortality and in-hospital complications. Specifically, we demonstrated higher cardiac-related complications, transfusion and haemorrhage/haematoma rates in patients with ESRD than in others. Moreover, patients with ESRD are more likely to have prolonged length of stay in hospital, and incur higher hospital charges. Based on the findings of the present study, use of biopsy and active surveillance for small, carefully selected renal masses might be considered in patients with ESRD at high risk of morbidity and mortality after surgery. ⋯ Patients with ESRD are at substantially higher risk of adverse outcomes after nephrectomy. Most importantly, the in-hospital mortality rate is fivefold higher.
-
What's known on the subject? and What does the study add? Immediate surgery for major renal truma has led to a high rate of nephrectomy in comparison with an expectant management. We reviewed our case material on the management of severe blunt renal trauma in adults with emphasis on conservative management. Only shattered kidneys and pedicle avulsion required immediate surgery. ⋯ Conservative management of grade 3-5 blunt renal trauma in haemodynamically stable patients yields more favourable results with high renal salvage rate. Grade 5 injuries still result in a nephrectomy rate of more than 80%. The absence of data on long-term outcomes and a potential inclusion bias due to the retrospective nature of the data represent major limitations of this review.